Hospitals and family doctors, the mainstays of health care, are pulling out of poor city neighborhoods, where the sickest populations live…. The Post-Gazette/Journal Sentinel analysis shows that nearly two-thirds of the roughly 230 hospitals opened since 2000 are in wealthier, often suburban, areas. As health systems open those facilities, they have been closing their urban counterparts. The number of hospitals in 52 major cities in the United States has fallen from its peak of 781 in 1970 to 426 in 2010, a drop of nearly 46%, according to a separate study…. Between 1990 and 2010 alone, 148 nonprofit hospitals closed in the largest American cities, along with 53 for-profit hospitals. In addition, five public hospitals closed, according to Alan Sager of Boston University, who has tracked and studied hospital closures in the United States. His research shows it’s not just poor-performing hospitals being closed; the ones that shut down often are rated as being more efficient than those that remain…. The shifting economics of health care pulled hospitals from what had once been their primary purpose: serving the needy. As hospitals saw poor patients as toxic to their financial health, the percentage of charitable care given by U.S. hospitals dropped…..
Source: Dwight V. Denison, Jacob Fowles, Michael Moody, Public Budgeting & Finance, Vol. 34, Issue 2, Summer 2014
From the abstract:
Institutions of higher education provide an excellent opportunity to compare long‐term debt financing in the nonprofit and public sectors. The proposed models explain the long‐term debt per student at public and private‐nonprofit research universities. Student enrollment, enrollment growth, total assets, and revenue variables as a group all influence debt levels. The strongest predictors of debt balances are the fixed characteristics of the universities themselves. Empirical evidence from the university sector also suggests the absence of a powerful arbitrage incentive to issue debt.
Health Care System Unlawfully Fired Employee Because of Vision/Hearing Impairment and to Punish Her for Seeking Accommodation, Federal Agency Charged
Upper Chesapeake Health System, Inc., a leading health care provider in northeastern Maryland, will pay $180,000 and furnish significant equitable relief to settle an EEOC disability discrimination and retaliation lawsuit, the U.S. Equal Employment Opportunity Commission (EEOC) announced today. According to the EEOC’s suit, Deborah Ropiski consistently received good performance evaluations and positive patient feedback during her 19 years of employment with the Upper Chesapeake Health System. The EEOC charged that the health care system failed to reassign Ropiski as a reasonable accommodation after it removed her from her position as a pulmonary function technologist at its Bel Air, Md., medical center based on its perception that her disability, Usher’s syndrome, interfered with her ability to do her job. Usher’s syndrome is a genetic disorder characterized by varying levels of vision and hearing loss. According to the lawsuit, Upper Chesapeake Health System terminated Ropiski because of her disability and in retaliation for her requests for accommodations. The EEOC also charged that the health care system later failed to rehire Ropiski into a vacant position for which she was qualified because of her disability and in retaliation for her filing a discrimination charge with the EEOC….
University Of Maryland Medical System Celebrates 25th Anniversary As A Private, Non-Profit Health System
Source: University of Maryland Medical System, Press Release, October 29, 2009
The University of Maryland Medical System is celebrating the 25th anniversary of its transformation from an aging, state-run hospital in 1984 to a successful private, non-profit network of 11 academic, community and specialty hospitals throughout Maryland with more than 15,000 employees and almost $2.5 billion in annual revenue…. The transformation took place when the Maryland General Assembly and then-Governor Harry Hughes enacted a law in 1984 enabling the University of Maryland Hospital, located in downtown Baltimore, to change its governance from the state to a private, non-profit corporation led by a board of directors comprised of top area business, legislative and community leaders…. The University of Maryland Medical System includes: University of Maryland Medical Center …. Baltimore Washington Medical Center …. Chester River Health System …. Kernan Hospital …. Maryland General Hospital …. Shore Health System …. Mt. Washington Pediatric Hospital …. University Specialty Hospital …. Upper Chesapeake Health System ….
Source: Jennifer E. Mosley, American Review of Public Administration, Vol. 44 no. 3, May 2014
From the abstract:
Participation in collaborative advocacy organizations is one of the most common advocacy tactics pursued by nonprofit organizations. However, field-level dynamics and norms around collaboration may be changing with the growth of public-private intermediary organizations. Using a lens that brings together theories of structuration and institutional entrepreneurship, this research investigates (a) how intermediary organizations structure advocacy opportunities and institutionalize new advocacy practices at the field level, and (b) how member organizations interpret those opportunities and practices. Qualitative findings from a regional homeless services policy field demonstrate that intermediary organizations gain members and thus, power, based on their position in the policy field and through their ability to connect members to valuable government contacts. In this field, participation in public-private intermediary organizations has surpassed involvement in traditional advocacy coalitions as providers are motivated to meet organizational legitimacy goals as much as advocacy goals.
Source: Jaclyn Schede Piatak, Journal of Public Administration Research and Theory, First published online: April 2, 2014
From the abstract:
The face of public service continues to evolve as government copes with increasingly complex societal problems and changing means of service delivery. Public managers are now challenged to oversee programs that cut across sectors and organizational boundaries, and people carrying out the government’s work can be found across all sectors—government, nonprofit, and for-profit. Unlike those in previous generations, younger individuals see opportunities to engage in public service in nonprofit and for-profit organizations, which has undoubtedly affected the ability of government agencies to recruit and retain those with public service values. Have opportunities to engage in public service across sectors made differences between public, nonprofit, and for-profit organizations irrelevant? Are public and nonprofit employees any different from those in for-profit organizations, especially when it comes to public service values? Understanding why individuals engage in public service is arguably more important than ever as social capital and civic engagement decline. This article draws upon the “other-oriented” aspect of public service and builds upon the work of Brewer … and Houston … to examine the impact of sector on one area of prosocial behavior: volunteering. This article employs data from the September Volunteer Supplement of the 2011 Current Population Survey to examine how both formal and informal volunteering varies across sectors—public, nonprofit, and for-profit—as well as across levels of government—federal, state, and local. This study finds that government and nonprofit sector employees tend to volunteer more than their for-profit sector counterparts, but there are important nuances when taking work schedule, levels of government, and additional measures of volunteering into account.
Nonprofit hospitals enjoy tax benefits worth $13 billion a year, but what do taxpayers get in return? …
…A 100Reporters survey of dozens of nonprofit hospital financial reports to the Internal Revenue Service suggests that not all of them need charity. In California alone, at least 100 executives at nonprofit hospitals earn more than $1 million a year. Eleven of them are at Cedars-Sinai.
Indeed, many large not-for-profit hospitals are throwing grand parties, collecting pricey art, paying their executives private-sector wages, making loans to high-ranking employees, sponsoring football teams, extending their global reach and stashing cash overseas – all factors in what economist Paul Krugman has called the nation’s No. 1 economic woe–high healthcare costs….
Empire Janitorial Sales and Services Inc. of Metairie has paid more than $277,500 in back wages to current and former workers employed by subcontractor Acadian Payroll Services LLC, the result of an investigation into overtime pay violations, the U.S. Department of Labor said this week. The Labor Department said 233 janitorial service workers were wrongfully classified as independent contractors and were not paid overtime wages for working more than 40 hours in a week. The janitors worked at the Ernest N. Morial Convention Center and other sites. Federal law requires employees to be paid time and one-half after they work for 40 hours in a week, but the janitors were paid a regular rate for the overtime, the department said….
The Tampa Bay Times spent a year investigating Florida trauma centers and what they charge injured patients. The Times analyzed state-collected records for millions of hospital patients and interviewed dozens of people treated by Florida trauma centers. It is expensive to treat serious injuries, from car crashes, gun shots and catastrophic falls. But the Times investigation found that trauma centers across the state are charging a special fee, even to patients who need little more than first aid. The fee can reach $33,000 and can be charged with no advanced warning. It does not cover any medical care. All of that gets billed separately. In Florida trauma centers, this fee is the price of admission.
Interactive: Compare charges at Florida trauma centers
Interactive: How you could wind up with huge trauma charges
Graphic: Florida’s Trauma Toll
How HCA turned trauma into a money-maker
Source: Alexandra Zayas and Letitia Stein, Tampa Bay Times, March 8, 2014
Getting injured in Florida has never been more expensive. Hospital Corporation of America, the nation’s largest hospital chain, is a big reason why. How one company is driving up the cost of care across the state.
…. Absent from his narrative, though, was the back story, one that underscores a profound change taking place in the way science is paid for and practiced in America …. American science, long a source of national power and pride, is increasingly becoming a private enterprise. In Washington, budget cuts have left the nation’s research complex reeling. Labs are closing. Scientists are being laid off. Projects are being put on the shelf, especially in the risky, freewheeling realm of basic research. Yet from Silicon Valley to Wall Street, science philanthropy is hot, as many of the richest Americans seek to reinvent themselves as patrons of social progress through science research. The result is a new calculus of influence and priorities that the scientific community views with a mix of gratitude and trepidation. “For better or worse,” said Steven A. Edwards, a policy analyst at the American Association for the Advancement of Science, “the practice of science in the 21st century is becoming shaped less by national priorities or by peer-review groups and more by the particular preferences of individuals with huge amounts of money.” …. Many of the patrons, they say, are ignoring basic research — the kind that investigates the riddles of nature and has produced centuries of breakthroughs, even whole industries — for a jumble of popular, feel-good fields like environmental studies and space exploration. …
Source: Children and Youth Services Review, Volume 38, March 2014
* New directions for research on the organizational and institutional context of child welfare agencies: Introduction to the symposium on “The Organizational and Managerial Context of Private Child Welfare Agencies”
by Bowen McBeath, Crystal Collins-Camargo, Emmeline Chuang, Rebecca Wells, Alicia C. Bunger, Mónica Pérez Jolles
This paper argues for a conceptual reorientation to research and practice that emphasizes the prominence of institutional and organizational factors in the lives of those who are involved in child welfare systems. Current child welfare reform efforts are premised on the idea that agencies—their structures, management, and internal approaches to organizing their workforce and frontline services—may be influential drivers of and barriers to innovation in practice and policy. We unpack this premise by providing an introduction to the institutional and organizational context of child welfare practice that highlights the diverse contexts and contributions of public and private child welfare agencies. We then review five domains for future research and present examples of studies that might be undertaken. The paper concludes by introducing the symposium papers and identifying their contributions to child welfare and human service research.
* Trends in local public child welfare agencies 1999–2009
by Rebecca Wells, Mónica Pérez Jolles, Emmeline Chuang, Bowen McBeath, Crystal Collins-Camargo
US public child welfare agencies have faced increasing pressure in the first decade of this century to demonstrate efficiency and accountability, even as the Great Recession increased pressures on millions of families and undermined human service funding. This paper reports on analyses of the two cohorts of local public child welfare agencies from the National Survey of Child and Adolescent Well-Being to identify changes in their structure and practice. Local agency adaptations have included some structural integration and apparently increased use of subcontracting, including investigations. Collectively, these trends appear to be fostering tighter coupling of local child welfare agencies with other service providers. Some of these connections may improve families’ access to a range of services. However, the increased reliance on private providers may also undermine accountability and flexibility to respond to changing needs.
* An empirical typology of private child and family serving agencies
by Emmeline Chuang, Crystal Collins-Camargo, Bowen McBeath, Rebecca Wells, Alicia Bunger
Differences in how services are organized and delivered can contribute significantly to variation in outcomes experienced by children and families. However, few comparative studies identify the strengths and limitations of alternative delivery system configurations. The current study provides the first empirical typology of private agencies involved with the formal child welfare system. Data collected in 2011 from a national sample of private agencies were used to classify agencies into five distinct groups based on internal management capacity, service diversification, integration, and policy advocacy. Findings reveal considerable heterogeneity in the population of private child and family serving agencies. Cross-group comparisons suggest that differences in agencies’ strategic and structural characteristics correlated with agency directors’ perceptions of different pressures in their external environment. Future research can use this typology to better understand local service systems and the extent to which different agency strategies affect performance and other outcomes. Such information has implications for public agency contracting decisions and could inform system-level assessment and planning of services for children and families.
* Collaboration, competition, and co-opetition: Interorganizational dynamics between private child welfare agencies and child serving sectors
by Alicia C. Bunger, Crystal Collins-Camargo, Bowen McBeath, Emmeline Chuang, Monica Pérez-Jolles, Rebecca Wells
Human service agencies are encouraged to collaborate with other public and private agencies in providing services to children and families. However, they also often compete with these same partners for funding, qualified staff, and clientele. Although little is known about complex interagency dynamics of competition and collaboration in the child-serving sector, evidence suggests that competition can undermine collaboration unless managed strategically. This study explores the interrelationship between competition and collaboration, sometimes referred to as “co-opetition.” Using a national dataset of private child and family serving agencies, we examine their relationships with other child serving sectors (N = 4460 pair-wise relationships), and explore how variations in patterns of collaboration and competition are associated with several organizational, environmental and relational factors. Results suggest that most relationships between private child welfare agencies and other child serving agencies are characterized by both competition and collaboration (i.e. “co-opetition”), and is most frequently reported with other local private child welfare agencies. Logistic regression analyses indicate that co-opetition is likely to occur when private child welfare agencies have a good perceived relationship or a sub-contract with their partner. Findings have implications for how agency leaders manage partner relationships, and how public child welfare administrators structure contracts.
* Organizational responsiveness to children and families: Findings from a national survey of nonprofit child welfare agencies
by Bowen McBeath, Mónica Pérez Jolles, Emmeline Chuang, Alicia C. Bunger, Crystal Collins-Camargo
Although child welfare practice at the frontline, organizational, and systemic levels is predicated on responsiveness to children and families, research has not determined why some child welfare agencies are more responsive to consumers than others. This study examines the influence of children and families on agency operations (“consumer-centricity”) among a national sample of nonprofit child welfare agencies. In testing for external and internal determinants of consumer-centricity, we find that agencies reported a high level of consumer-centricity overall. Multivariate analyses indicate that interorganizational competition was the principal predictor of consumer-centricity; in contrast, internal agency attributes such as administrative infrastructural supports and accreditation status, service technology, agency leadership, and structural characteristics were not associated with consumer-centricity. We propose three areas for continuing child welfare research on consumer-centricity and identify direct and indirect strategies that child welfare policymakers and practitioners may use to promote consumer-centricity among nonprofit child welfare agencies.
* Private child welfare agency managers’ perceptions of the effectiveness of different performance management strategies
by Crystal Collins-Camargo, Emmeline Chuang, Bowen McBeath, Alicia C. Bunger
In all states, public and private child welfare agencies partner in an effort to deliver effective and accountable services to children and families (Collins-Camargo, Ensign, & Flaherty, 2008). While anecdotal information suggests that managers in competitive markets have incentives to carefully select and implement performance management strategies (McBeath, Briggs, & Aisenberg, 2009; Smith, 2010), little is known about the effectiveness of these strategies. This paper explores managerial perceptions regarding the usefulness of three techniques for performance management: supervisory review within the human resources model; priority review within internal processes; and outcomes management within the rational goal model. Managerial perceptions of the effectiveness of these efforts are examined in relation to organizational characteristics, capacity, and interagency competition.
* Private child and family serving agencies: Implications of national survey results for policy and managerial practice
by Crystal Collins-Camargo, Mary Hollie, Bowen McBeath
The national studies represented in this symposium provide the field with greater understanding of the nature of the private sector’s role in child welfare and the complex interrelationships among organizational characteristics, inter-organizational dynamics, and external influences. Research findings from symposium papers are examined through the lens of a private agency manager and implications are derived for managerial practice and policy practice both within the private agency and in relation to public/private child welfare partnerships. Key managerial competencies that may be required to move agencies and the sector towards enhanced organizational performance and child welfare outcomes are discussed.